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Suffering from lingering COVID-19 symptoms post-illness? Which states were added back to Chicago’s emergency travel advisory?

Enduring symptoms of COVID-19 after diagnosis? Illinois is looking to help those long haulers. Which states were added back to Chicago’s emergency travel advisory? These are some of the many questions readers have sent us that we’ve put to health and science experts. This resource will be updated as more questions arrive, so check back often. Have your own pandemic question? Send it to the Tribune here. Get the latest Chicago COVID-19 information and updates from Chicago Tribune reporters and editors on our COVID-19 Facebook page.

Suffering from lingering COVID-19 symptoms after dealing with coronavirus? Illinois looking to help long haulers.

Long COVID-19 is a range of symptoms that can last weeks or months after first being infected with COVID-19 or can appear weeks after infection, according to the Centers for Disease Control and Prevention. Symptoms of long COVID-19 vary greatly — some of the most common symptoms include fatigue, difficulty breathing, difficulty concentrating, body or muscle aches, problems with taste or smell, trouble sleeping, feeling anxious or depressed, dizziness and weakness — and the risk of becoming a long-hauler increases with the severity of illness after infection.

It can happen to anyone who has had COVID-19.

Estimates suggest 10% to 30% of people who get COVID-19 will develop long COVID-19, according to Dr. Jerry Krishnan, University of Illinois Chicago associate vice chancellor for population health sciences and professor of medicine and public health.

“The CDC estimates that about 33 million Americans tested positive for COVID-19, which means 3 to 10 million Americans likely have or have had long COVID,” Krishnan said.

National and local initiatives are being formed to understand and treat patients with the condition.

UIC has been selected to lead an Illinois-based team for the U.S. RECOVER consortium. Krishnan is a part of the team spearheading the efforts to bring health centers, community-based organizations and faith-based organizations in Chicago, Peoria, Rockford and Urbana together to form a network of state resources for a directory that can be available to people with long COVID-19.

There is no test for long COVID-19, Krishnan said. Serology tests used to look for antibodies in the blood are the best gauge for diagnosis, he said. Finding a doctor who knows about testing and best practices from current data is necessary to prevent confusion with other health conditions, he said.

“We’re going to have to rethink where to care for these individuals,” Krishnan said. “The other piece is we got to be careful because we don’t know yet what to do for these individuals.”

Which states were added back to Chicago’s emergency travel advisory?

Missouri and Arkansas are the only two states where unvaccinated travelers returning to Chicago will be asked to abide by quarantine or COVID-19 test requirements, according to the Chicago Department of Public Health. The list is updated every two weeks and travel guidance on new states goes into effect on July 16.

Missouri and Arkansas were added this week because they met the threshold of at least 15 daily cases per 100,000 residents. Once a state breaches that ceiling, travelers returning from there to Chicago are advised to be fully vaccinated, quarantine for 10 days or test negative for COVID-19 no more than 72 hours before arrival.

Since the start of June, no states had been on the city’s COVID-19 travel restriction list thanks to vaccinations. But as the more contagious delta variant began spreading and states hit a wall with vaccine outreach, positive tests began creeping up again. That variant has become the dominant strain in the country.

What do we need to know about the delta variant?

Local health officials say nearly 10,000 cases of the various COVID-19 variants reported in Illinois as of June 27 are not yet cause for alarm.

Gov. J.B. Pritzker said June 28 that the delta variant already is a “growing presence in Illinois,” and officials expect it to be the dominant strain statewide by fall.

Dr. Emily Landon, chief health care epidemiologist at the University of Chicago, said the delta variant is “even more contagious than the alpha variant,” but vaccination efforts throughout the state should keep the spread limited.

“Fully vaccinated people really don’t need to be concerned,” Landon said. “All of the vaccines that are available in the U.S. work well with the delta variant but don’t work as well as protecting you from the original COVID. But, we’re talking about 95 and 90%, which is not significant enough to make me want to change how people are behaving.

“Where you see fewer vaccinated individuals, you’re more likely to have an outbreak. When you have COVID spreading in your community, everybody is at higher risk, including the people that are vaccinated. Certain communities, certain parts of the country are more likely to be protected because they have more people who are vaccinated.

“Unvaccinated children are still unvaccinated. Even if the rest of the family is all vaccinated, if you take unvaccinated kids to a COVID hot spot, they could get it and bring it back to your community and spread it.”

— Shanzeh Ahmad and Alice Yin

“By adulthood, we have come into contact with many types of viruses and bacteria,” she said. “Our immune system has created memory to these pathogens, so that when we come into contact with them we can make antibodies to fight off the disease.”

Vaccines are important for novel pathogens, like COVID-19, she noted.

What types of childhood illnesses are cropping up this summer?

Dr. Rosibell Arcia-Diaz, a pediatrician with Cook County Health, said June 22 that this month doctors have seen a few kids with rashes, and many children with runny noses who have contracted viruses, including the rhinovirus, a cold that is common during the summer months.

While RSV — respiratory syncytial virus — lingered a little longer than usual this year, Arcia-Diaz said that with school out for the summer, pediatricians have not seen a lot of strep throat, which she said is easily transmitted by students in classrooms.

Still, Arcia-Diaz warned that parents who have not taken their children to see their pediatrician since COVID-19 arrived nearly 16 months ago should ensure this summer that their family is up to date on wellness checks and immunizations.

And for children age 12 and older, parents can check with their pediatrician to see if the COVID-19 vaccine is available.

“We’re definitely encouraging parents to be proactive, and to schedule their children’s appointments early on this summer, so the kids will be caught up on their immunizations before the start of the new school year,” Arcia-Diaz said.

Why is mask shaming still happening now that Illinois has reopened?

The Centers for Disease Control and Prevention no longer recommends that fully vaccinated people wear a mask in many situations, but masks are required on buses, planes and trains, and in hospitals, prisons, homeless shelters and businesses that require them. It’s recommended that unvaccinated people continue to wear masks in many public settings.

But seeing a mask on strangers may trigger some people to offer a negative opinion, leading to a round of mask shaming.

Laurie Zoloth, a bioethicist at the University of Chicago who has advised federal health agencies and considered many of the complicated moral questions raised by the pandemic, says the move is one of the political differences playing out in the public arena.

As she describes it: “There was a moment for every one of us when we realized that we were being overcome by an extraordinarily powerful force (the pandemic) that we couldn’t control. People reacted to it in two very different ways. Some people wore a mask, saying I take this seriously, I’m in reality and I’m cautious. For others, the mask served to remind them of a painful truth they would rather deny. For those people, seeing someone wearing a mask is very destabilizing, because here’s someone wearing the visible sign of catastrophe, and they don’t want to be reminded of that tragic reality. One way to do that is to politicize it and to mock it and to make the person wearing the mask feel like they have it wrong. Then they reassert their vision of reality. That’s what’s behind the politicalization (of masks).”

Zoloth says folks shouldn’t be shamed for wearing masks or not feeling like the pandemic is completely over.

“You could be wearing a mask because you have an autoimmune disease, or because you’re not fully vaccinated, or because you live with someone whose health is considered fragile, or you just had surgery or any number of health conditions that really are not anyone else’s business,” she said. “Understand that putting one on is not an admission of defeat or signal that you’re neurotic. It’s just a sign that you understand how profound this pandemic was and how it still represents a threat. We should be really humble and understand how much further we have to go.”

How prevalent is the Delta variant in Illinois?

The Illinois Department of Public Health has identified 64 cases of the variant, a COVID-19 strain first found in India that federal health officials have labeled a “variant of concern.”

The state’s health department has identified more than 9,400 variant cases of the virus in Illinois, more than 6,300 of which are the Alpha variant, first found in the United Kingdom. The next biggest slice comes from the Gamma variant, first identified in travelers from Brazil, with more than 2,400 cases.

Though identified cases of the Delta variant make up the smallest number of variants in Illinois so far, the Centers for Disease Control and Prevention has estimated that it may account for about 10% of emerging COVID-19 infections in the United States.

Speaking to NPR on June 17, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, urged people to get vaccinated to help combat the spread of the Delta variant.

“If you are vaccinated, you’re going to be protected, which is another very good reason to encourage people strongly to get vaccinated,” Fauci told NPR’s “Morning Edition.” “If you are not vaccinated, you are at risk of getting infected with the virus that now spreads more rapidly and gives more serious disease.”

— Madeline Buckley and Dan Petrella

Should people who have already been fully vaccinated with Moderna or Pfizer, also get a J&J shot? Will this improve protection?

“There is no evidence that extra doses of vaccine are necessary at this time,” said Dr. John Segreti medical director of infection control and prevention at Rush University. “The response seems robust, durable and real-life surveys have confirmed high level of efficacy seen in the trials.”

He added that no matter which vaccine, the only way a vaccinated person can add to their protection is by helping get others vaccinated.

When we get a booster shot, will it have the same level of side effects?

We don’t yet know if booster doses, which augment vaccine effectiveness, will be needed, noted Dr. John Segreti of Rush University. He added that there are several booster studies underway that should inform us of the possible side effects.

I donate whole blood every 8 weeks. Should I be concerned about donating blood after the vaccination process? Will losing blood affect my immune response?

According to a statement from the American Red Cross, there is no deferral time for eligible blood donors who are vaccinated. Donating blood after receiving a vaccine does not reduce protection from the virus, the American Red Cross said. Similar to other vaccines such as measles, mumps or influenza, the COVID-19 vaccine generates an immune response to help protect from illness; this is not affected by giving blood.

What are the guidelines for phase 5 in Chicago and Illinois?

Here is a guide for what to expect.

When does phase five start? Friday, June 11.

Where will masks still be required? Masks will still be required for everyone, even vaccinated people, on public transit, at the airport, and in schools, hospitals and other congregate settings. The state is now adjusting guidelines for outdoor mask wearing at schools, dropping the requirement in most situations.

What should people who aren’t vaccinated do? The state recommends unvaccinated people should wear masks — and stay socially distanced — in crowded places inside and outside.

With the recent easing of COVID-19 restrictions coinciding with seasonal gatherings like graduation parties, how can we safely mingle in social settings with friends and family members who are not vaccinated?

Dr. Robert Murphy, executive director of the Institute for Global Health at Northwestern University Feinberg School of Medicine, said vaccinated people who don’t have immunodeficiency (meaning no active cancers, no organ transplants, no one on immunosuppressive therapy) “are very safe from getting symptomatic COVID-19, hospitalization and death. A relatively small number may get infected but for the most part, without symptoms. They essentially have no restrictions and no longer have to use masks except in hospitals, medical facilities, long term care residences.”

Murphy noted that local or state regulations “may be more strict, for now anyway.”

He also pointed out that unvaccinated people “will continue to become infected, about 15% will get very ill and may end up in the hospital, and 1-2% will die from COVID-19. This is where the epidemic is going now.”

Many local stores have signs saying masks are optional but recommended for those who aren’t vaccinated. But should those of us who are vaccinated still wear a mask indoors, at least for the short term?

Murphy’s response was no. “I follow the science,” he said. “Masks are no longer needed for fully vaccinated persons in most situations indoors or outdoors.”

For families who are planning summer vacations, but have kids under 12 who are still too young for the vaccine, is there a safe way to travel that would mitigate risk for the unvaccinated?

“Not really,” Murphy said. “Vaccines are now approved at 12 years and older. Younger children, if they do get infected, typically have very mild disease if otherwise healthy. They will be at risk for infection like everyone else who is not vaccinated. They just handle the infection better.”

Swollen lymph nodes have been mistaken for cancer after Pfizer and Moderna vaccination shots. Does J&J have the same possibility, even though it approaches the coronavirus in an entirely different way?

Dr. Deepa Sheth, a radiologist and breast imaging specialist at the University of Chicago Medicine, says all the recent research journal articles focus on the Pfizer and Moderna vaccines, so there isn’t any data yet on the Johnson & Johnson shot

“But the prior guidelines and recommendations should theoretically remain the same since this vaccine also boosts your immune response,” she said. “Getting a COVID-19 vaccine might result in swollen lymph nodes under the arm in which the injection was given. These swollen lymph nodes under the arm might show up on a mammogram done to screen for breast cancer.”

Women are encouraged to wait four to six weeks from the date of their last COVID-19 vaccine before undergoing a routine screening mammogram. But if one has any breast-related complaints (i.e. skin changes, nipple discharge, breast mass, breast pain, underarm swelling), Sheth said don’t delay coming going in for a mammogram.

Where do I need to wear a mask under the new Illinois and Chicago guidelines?

According to that guidance, people who are fully vaccinated should still wear masks in health care settings or while riding trains, buses, planes or other forms of public transportation, as well as including at airports, bus stations or train stations.

Should pregnant women feel safe taking a COVID-19 vaccine?

Agency Director Rochelle WalenskyCQ announced the recommendation during an update on the pandemic at a White House briefing Friday, April 23. She noted that a CDC study published this week found no safety concerns with Moderna and Pfizer vaccinations given during the third trimester of pregnancy.

The new study is based on reports from pregnant women who got shots soon after the vaccines became available. The researchers called for more data, including from vaccination earlier in pregnancy.

Pregnant women were excluded from COVID-19 vaccination studies, although there is limited safety data on some who became pregnant after enrolling.

“We know that this is a deeply personal decision, and I encourage people to talk to their doctors or primary care providers to determine what is best for them and for their baby,” Walensky said.

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